Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

I have been trying to find information about studies that would
show how the safety of homebirth relates to the distance to the
hospital. In other words, what is, or is there a safe distance from
hospital for a homebirth. I have come across many places that say
that about 30 mins is a safe distance and many midwives refuse to
attend homebirths if the distance is longer, but I haven't been
able to find what basis this decision is usually made on. I also
found that for example in England, in a place called cornwall local
midwives favour homebirths although the closest hospitals are 45-60
mins away because they say the long journey is an unnecessary risk
to the birthing mothers.

The reason I am asking this is because I live about 50-60 mins away
from the closest birthing hospital, and am still considering a home
birth. Where I live there really are no options, no birth centers,
etc. The hospital (as well as the others furher away) are places
where you cannot even chose who your care provider is going to be.
It is midwife led, but there are countless "standard
procedures" (=interventions) that are unneccessary and I would like
to avoid. I also have no way of chosing who the midwife who would
be in charge of me would be as it just depends on who's in turn
when the birth takes place (care during pregnancy is done by
community nurses who are not involved in birth). I had a very
negative experience with the birth of my second child in a local
hospital, which amounted to birth trauma and ppd. I don't want this
to happen again, but I also don't want to be stupid and take a risk
if I simply live too far from a hospital to have a safe home birth.
The distance is an issue to local home birth midwives. Ironically
the ones closer refused to assist a birth here, but I have found
one who lives 2hrs away who is willing to travel here for my birth
(my previous two have been very slow
births).

So if you are aware of any studies or facts that would help me
research and understand this issue and make a truly informed choice
I would be very thankful for your help.

I am not aware of any research on this point. I think, though,
that the 30 minute limit is based on a rule of thumb that a
hospital ought to be able to perform an urgent cesarean within
30 minutes of making the decision, a.k.a. "30 minutes
decision-to-incision." By extension, women laboring outside of the
hospital should live no further than 30 minutes away so that
by calling ahead, the hospital could be prepared to operate
within that time frame.

I am not aware of any evidence basis for this rule--in
fact, just the opposite. As Amy Romano, my co-author, wrote in the
birth center chapter of Optimal Care in Childbirth,
because the 30 minute rule is invoked by plaintiffs in malpractice
cases, obstetricians have been motivated to establish that
they should not be held to it. We have studies,
therefore, showing that outcomes correlate poorly with
decision-to-incision times, that even in well-equipped and staffed
hospitals many urgent cesareans begin beyond that 30-minute limit,
and that no interval between decision and cesarean, however brief,
guarantees a healthy baby. (See below.)

Is it possible that something could go so seriously wrong in
this next labor that inability to get to the hospital within 30
minutes could make a difference? Yes, but it isn't likely,
especially if you have no medical risk factors and considering that
this is your third baby. That being said, if something went that
wrong, that fast, it is also possible that living closer or even
being in the hospital, especially if it is a community hospital and
not equipped and staffed for urgent cesareans 24/7, wouldn't make a
difference. If you could obtain optimal care in your local
hospital, a case could be made that you might be better off
there, but as you relate, your local hospital is far from providing
care that best promotes safe, healthy birth.